Carpals “Some Lovers Try Positions That They Can’t Handle”
Flexor Retinaculum or Transverse Carpal Ligament Origin: scaphoid and trapesium on thumb side Insertion: pisiform and hamate on pinky side Action: stretches across carpal bones creating carpal tunnel for flexor tendon and median nerve to pass
Flexor Retinaculum Tps Trigger Points and Referrals: No Tps as it is a ligament, though injury or compression of median nerve may cause pain, numbness, lack of mobility in hand.
Flexor Retinaculum Exercise Stretch: place palm on table with fingers and thumb abducted and hyperflex wrist; or hold and stretch with other hand Strengthen: curl fingers into palm and hyperflex wrist
Opponens Pollicis Origin: flexor retinaculum and tubercle of trapezium bone Insertion: radial side of entire length of 1 st metacarpal bone. Action: flexes and abducts the 1 st metacarpal with slight medial rotation – brings thumb across palm to ring finger pad
Flexor Pollicis Brevis Origin: superficial head: distal border of flexor retic and tubercle of trapezium; deep head: trapezoid and capitate Insertion: radial side of base of proximal phalanx of thumb Action: flexes proximal phalanx of thumb; flexes 1 st metacarpal and rotates medially
Abductor Pollicis Brevis Origin: Flexor retinaculum and tubercles of scaphoid and trapezium Insertion: Lateral side of base of proximal phalanx of thumb Action: Abducts thumb and helps oppose it
Thumb Flexor TPs Trigger Point: in the belly of the muscle – “weeder’s thumb” Referrals: anterior length of thumb and medial wrist (above and beneath point); lateral side of thumb for abductors
Opponens Pollicis Exercise Stretch: Passively hyper-abduct the extended thumb with fingers of the opposite hand Strengthen: Press thumb and pinky together
Flexor Pollicis Brevis Exercise Stretch: Passively hyper-abduct the extended thumb with fingers of the opposite hand Strengthen: resisted thumb flex with rubber band anchored
Abductor Pollicis Brevis Exercise Strengthen/stretch: abduct with fingers in rubber band, then relax
Opponens digiti minimi Origin: Hamulus or hook of the hamate bone and flexor retinaculum Insertion: entire length of ulnar border of 5 th metacarpal. Action: flexes and slightly laterally rotates 5 th metacarpal. Helps to cup the palm of the hand
Flexor Digiti Minimi Brevis Origin: Hook of hamate and flexor retinaculum Insertion: Medial side of base of proximal phalanx of little finger Action: Flexes proximal phalanx of little (5th) finger
Abductor Digiti Minimi Origin: Pisiform Insertion: Medial side of base of proximal phalanx of little finger Action: Abducts little (5th) finger
Abductor Digiti Minimi TPs Trigger Point: in the belly of the muscle Referrals: down posterior and lateral side of pinky; similar areas for Opponens and Flexor digiti minimi only anterior side
Opponens Digiti Minimi Exercise Stretch: Passively hyper-extend the pinky with fingers of the opposite hand Strengthen: squeeze pinky and thumb together and hold for 20 sec
Flexor Digiti Minimi Brevis Exercise Stretch: same as thumb stretch but stretch pinky instead Strengthen: resisted pinky flexion with rubber band
Abductor Digiti Minimi Exercise Stretch: stretch pinky laterally Strengthen: place rubber band around extended fingers and abduct
Palmaris Brevis Origin: flexor retinaculum and palmar apneurosis Insertion: skin of palm into dermis Action: steadies and corrugates skin of palm to help with grip; contract palm
Palmaris Brevis TPs Trigger Point: in the belly of the muscle – Referrals: length of anterior edge of palm on pinky side and wrist
Palmaris Brevis Exercise Stretch: stretch thumb back with other hand Strengthen: squeeze fingers together tightly
Palmaris Longus Origin: Common flexor tendon from medial epicondyle of humerus Insertion:Distal half of flexor retinaculum and palmar aponeurosis Action:Flexes hand (at wrist) and tightens palmar aponeurosis
Palmaris Longus TPs Trigger Point: in the belly of the muscle Referrals: distal to palm of hand and up forearm
Palmaris Longus Exercise Stretch: passive stretch of palm by extending wrist with other hand Strengthen: resisted wrist flexion with theraband
Triceps Brachii Origin: Long head: infraglenoid tubercle of scapula; Lateral head: posterior surface of humerus, superior to radial groove; Medial head: posterior surface of humerus, inferior to radial groove Insertion:Proximal end of olecranon process of ulna and fascia of forearm Action:Chief extensor of forearm;
Triceps Brachii TPs 1-2 TP1: in the belly of the long head TP1 Referrals: strong referral to posterior deltoid and lateral condyle of the humerus. Spillover from base of neck, across shoulder, down posterior upper arm and forearm TP2: lower belly of medial head TP2 Referral: refers strongly to lateral condyle of humerus with spillover down lateral posterior forearm.
Triceps Brachii TPs 3-4 TP3: upper portion of muscle belly of medial head TP3 Referrals: strong around itself with spillover surrounding it and down posterior forearm into posterior ring and pinky fingers TP4: in long, dense tendonabove insertion TP4 Referrals: strongly into olecranon process
Triceps Brachii TPs 5 Tp5: in muscle belly on anterior surface of medial head. Tp5 Referrals: strong referral just below Tp on anterior surface of humerus – spills over down anterior forearm and anterior side of ring and pinky
Triceps Brachii Exercise Stretch: place one hand on scapula same side and other behind back – pull towel between for stretch in upper triceps Strengthen: with theraband anchored in front at chest level, pull down and back 20 reps.
Anconeus Origin: Posterior surface of lateral epicondyle of humerus Insertion:Lateral surface of olecranon and superior part of posterior surface of ulna Action: Extension and pronation of forearm at elbow
Anconeus TPs Trigger Point: in the belly of the muscle close to insertion of ulna Referrals: lateral epicondyle of humerus (tennis elbow)
Anconeus Exercise Stretch: Holding weight palm back, arm extended, flex and supinate arm across body Strengthen: extend and pronate forearm away from body Supinate! Pronate!
Sources Granger, Jocelyn. Neuromuscular Therapy Manual. Lippencott, 2011. Travell, J. and Simons, D. Myofascial Pain and Dysfunction, Vol. 1. Williams and Wilkins, 1983. Flash Anatomy flash cards: The Muscles. Bryan Edwards Publications, 1991. http://en.wikipedia.org/wiki/Flexor_retinaculum_of_the_h and http://www.rad.washington.edu/academics/academic- sections/msk/muscle-atlas/upper-body http://ict4us.com/r.kuijt/en_carpalbones.htm